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Paulus Kirchhof, Stefan Schroeder, on behalf of the European Society of Cardiology Cardiovascular Roundtable, NOACs in Atrial Fibrillation, European Heart Journal, Volume 38, Issue 31, 14 August 2017, Pages 2382–2385, https://doi.org/10.1093/eurheartj/ehx407
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Current Considerations for Novel Oral Anti-Coagulants (NOACs) in Atrial Fibrillation from the European Society of Cardiology Cardiovascular Roundtable
Introduction
The Cardiovascular Round Table (CRT) of the European Society of Cardiology (ESC) convened a regulatory workshop (27–28 March 2017) to discuss three major concepts involving oral anticoagulation in patients with atrial fibrillation (AF):
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This CardioPulse article summarizes the key outputs from the workshop and identifies areas of unmet need that should be high priorities for research.
Improving early detection and diagnosis of atrial fibrillation
Population screening
The 2016 ESC guidelines for the management of AF recommend opportunistic screening by pulse taking or electrocardiogram (ECG) rhythm strip in patients >65 years of age.1 The purpose of detecting asymptomatic AF is largely to allow initiation of anticoagulation therapy to prevent complications of AF. However, this method will only identify AF in a minority of patients with paroxysmal AF, as evidenced by studies using repeated or prolonged ECG screening, e.g. patient-operated devices or long-term ECG monitoring. The risk of AF-related complications is probably elevated in patients in whom paroxysmal AF is detected by such prolonged monitoring. Ongoing studies will determine the risks and benefits of oral anticoagulation in such patients. In addition, many consumer device types can detect an abnormal heart rhythm (e.g. smartphone apps using thumb sensors or smartphone ECGs). Consumer devices can only be used for pre-screening, but not for diagnosis. Potential episodes of AF must be confirmed by a physician-interpreted ECG to diagnose AF. Oral anticoagulation therapy should never be prescribed on the basis of pre-screening devices alone. Several uncertainties need to be addressed, including:
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